Surge in HVI on Navajo reservation alarms doctors

  • Article by: DAN FROSCH
  • New York Times
  • May 19, 2013 - 9:33 PM


– A surge in HIV infections on the Navajo Reservation here has doctors and public health workers increasingly alarmed that the virus that causes AIDS has resurfaced with renewed intensity in this impoverished region.

A report released last month by the federal Indian Health Service found there were 47 new diagnoses of human immunodeficiency virus on the reservation in 2012, up 20 percent from 2011. Since 1999, new HIV cases among Navajo are up nearly fivefold, the report found. The tally of new cases from last year represents the highest annual number recorded among the tribe by the health agency.

“I’m scared to death,” said Dr. Jonathan Iralu, an infectious disease specialist who runs an HIV clinic in this dusty town where old trading posts and ramshackle motels line the main drag on the edge of Navajo land, not far from the Arizona border. “The numbers show there is a dangerous rise, and the time to act is now, before it’s too late.”

Iralu, who compiled the report, remembers hearing stories from former colleagues about the late 1980s when AIDS first struck the reservation. Navajo men would walk into the Indian Medical Center in Gallup sick with a fever or a cough, and a few days later they would be dead.

In the period after that, Iralu, a Harvard-educated doctor who moved here from Boston, treated a small number of Navajo men with HIV each year and lost nearly a third of them.

As with other groups in the United States, infection rates on the reservation leveled off and deaths dropped, with help from new treatments and outreach seeking to cut through the stigma about AIDS among tribal members.

But over the past few years, the HIV numbers on Navajo land have crept up. That increase, Iralu said, can be partly attributed to the infection being detected earlier, thanks to years of HIV education programs and more routine screening.

But Iralu and other health workers also said the virus is now being transmitted from one tribal member to another, a disquieting trend. In past years, Navajo were thought to have contracted the disease mostly in cities and returned with it.

And though the numbers are still comparatively low — there are about 200 Navajo patients tracked by area clinics — the challenges of prevention are amplified in a place where sex is still rarely discussed publicly and infection is often hidden from loved ones.

Melvin Harrison, the executive director of the Navajo AIDS Network, which provides services for tribal members with HIV, said that of the 65 people his group treats, a majority have not told family or friends.

“That’s how big the stigma is here,” he said. “They are afraid of rejection.”

Harrison said that when he first started working on HIV education in the 1980s, Navajo elders cautioned him not to talk openly about HIV for fear that he would “wish it” upon the tribe.

Even now, he said, old cultural mores prevail, and gay Navajo men, who make up around 75 percent of the network’s clients, keep relationships private.

According to the recent report, men who have sex with men accounted for nearly half the new cases.

One Navajo man who contracted HIV from his partner in 2001 recalled how his mother refused to hug him and served him food on plastic plates when she found out he was infected.

The man, 48, who did not want to be identified because he has not told his entire family, said his mother eventually came to embrace him after he explained the ways HIV could and could not be transmitted.

But the man has not told his three brothers that he has HIV because he fears they will shun him. “I don’t think I’ll ever tell them,” he said. “I don’t want to be pushed out of their lives.”

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